Litigating Federal Health Care Legislation and the Interstices of Procedure,

Forward to the 2012 Allen Chair Symposium issue, focused on the litigation challenges to the Patient Protection and Affordable Care Act ("ACA").

Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use

Purpose: Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. Design: Cross-sectional online survey. Setting: Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. Participants: Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. Measures: Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. Analysis: Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. Results: Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. Conclusion: Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.

Personhood Status of the Human Zygote, Embryo, Fetus

The fields of biology, medicine, and embryology have described the developmental milestones of humans throughout gestation in great detail. It is less clear as to when humans are recognized as people, persons, or beings with rights that are protected by legislation. The practice of law is irrevocably intertwined with that of ethical conduct; and the time at which a human life is considered a person has implications that extend to health care, legislation on abortion, and autonomy of individuals. This article reviews the economical position that fertilization is the moment that personhood of the conceptus begins. Alternate positions proposing that personhood begins at other possible times after fertilization are presented and contrasted to the economical hypothesis. Summary This article is an original work critically analyzing the various arguments for human personhood at fertilization and thereafter. The various positions on human personhood are compared and contrasted herein. The time of the human lifespan at which personhood is conferred has important implications for health care, legislation, and personal autonomy.

Rendering Pediatric Palliative Medical Care on Outpatient Basis

The article discusses the complexity of interpretation of the current health care legislation in relation to the provision of pediatric palliative care on outpatient basis. It also introduces a comparative analysis of the current legislation and represents amendment proposals.

Critical Care Nurses’ Knowledge of Confidentiality Legislation

Background Health care legislation can be difficult to understand and apply in critical situations where patients may not be physically capable of autonomous control of confidential health information. Nurses are often the first to encounter confidential information about patients. Objectives To explore critical care nurses’ knowledge of federal and North Carolina state legislation regarding confidentiality. Methods This descriptive, qualitative study included 12 critical care nurses who were asked to describe their knowledge of federal confidentiality legislation and specific knowledge of North Carolina’s confidentiality legislation. Results Critical care nurses were knowledgeable about federal confidentiality laws but demonstrated a need for further education about state-specific legislation. Conclusion Nurses’ application of confidentiality legislation demonstrates their knowledge of confidentiality legislation. To continue the trusting relationship that nurses have traditionally held with patients and patients’ families, it is imperative for nurses to remain current about confidentiality legislation. Through education both before and after licensure, correct application of legislation can be achieved. Further research can aid in exploring the intersection between health care legislation and ethics.